Historical Perspective The seminal work of Pauling and colleagues on the properties of hemoglobin S provided the basis for a hypothesis that heralded the concept of “molecular medicine.” Indeed, sickle cell anemia a a SCD includes various genotypes, whereas Hb…
Introduction Injury is common. Small hospitals have emergency rooms, which deal with a spectrum of injuries, but intensive care of the most severely injured is highly centralized, taking place chiefly in regional trauma centers. It has been estimated that in…
Paradoxical embolization describes the passage of material, typically thrombus, from venous circulation into the systemic arterial circulation via a shunt. Presence of a right-to-left shunt is often the result of an atrial cardiac defect. In 1877, Dr. Julius Cohnheim, a…
Introduction Acute central nervous system (CNS) diseases are notable for two critical features. The first, and perhaps most obvious, is that these are diseases that are life threatening and likely to cause major permanent neurologic disability. In short, the consequences…
The coumarin-type oral anticoagulants have been in use for more than 70 years and are well-established weapons in the armamentarium against thrombotic disease. Their discovery evolved from investigations into a hemorrhagic disease of cattle occurring early in the 20th century…
Introduction The liver plays a pivotal role in thrombosis and hemostasis because it synthesizes many hemostatic proteins. All procoagulant plasma proteins; the anticoagulant plasma proteins except for tissue factor pathway inhibitor; the fibrinolytic plasma proteins plasminogen, α 2 -antiplasmin, thrombin-activatable…
Millions of people in the United States are on antithrombotic therapy—either antiplatelet therapy or anticoagulants—for treatment and prevention of venous and arterial thromboembolism. During a given year, as many as 10% of these patients will need an invasive procedure. How…
By observing and studying the effects of surgery and trauma on hemostasis—including physiologic as well as hypocoagulable and hypercoagulable situations—our understanding of the interrelationship between hemostasis and surgery has been advanced. The following six topics will be addressed in this…
Introduction Pregnancy is associated with an increased risk of venous thromboembolism (VTE). This increased risk is mediated by physiologic changes that occur during and immediately following pregnancy and that may have enhanced survival during evolution by decreasing hemorrhage at parturition.…
Introduction Successful management of bleeding in pregnancy requires an understanding of the various scenarios in pregnancy in which bleeding can arise. In this chapter the discussion is focused on pregnancy-related bleeding, including bleeding due to obstetric, surgical, and systemic causes.…